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Table 2 Perceived advantages and disadvantages of integrated treatment models: Emergent themes and representative quotes organized using the Bastemeijer et al. (2017) taxonomy

From: “It’s way more than just writing a prescription”: A qualitative study of preferences for integrated versus non-integrated treatment models among individuals with opioid use disorder

 

Factors influencing preferences for:

Theme

Integrated models

Non-integrated models

Patient values

Privacy and confidentiality

“When you go to a treatment program and stuff, it’s public. They’re not supposed to say anything, but it kinda becomes a public record. I mean, word gets out quick.”

-140, Male, 40 years

“I would like to go to a private facility that nobody knew about… and they don’t share information with anybody else. I just want to focus on getting better, as opposed to what else is going on with this information.”-135, Male, 30 years

Fear of consequences

“My struggle with addiction isn’t something that I readily share with [general medical providers]. One, because I want the doctor to not ever prescribe me pills again. And two, especially now that our entire healthcare system has moved to electronics, I don’t really have any state privacy.”

-138, Male, 33 years

Individualization

“The cool part about doing everything with him [general medical provider] would be that it would be really personal.”

–105, Female, 31 years

Characteristics of setting and provider

Convenience

Ease of access

“I mean, he [primary care doctor] is right in the same town that I live in, and it just would have been convenient.”

–116, Female, 29 years

Speed of access

“I wouldn’t have to wait to get approval to get seen.”

–105, Female, 31 years

“I think you’d have to make a doctor’s appointment, and sometimes you have to wait a long time before you can see a doctor. I think that would be a con [of integrated models] because I know when I go to see my doctor, I have to wait a frickin’ month before I can see him.”

–107, Male, 52 years

Cost

“I think that [integrated treatment] would help a lot of people. It would probably help a lot of people because it costs moey to get clean like that [non-integrated treatment models]… Like, going to the Suboxone doctor’s like hundreds and hundreds of dollars a month.”

–113, Female, 38 years

Effectiveness at treating OUD

“I don’t know if I would necessarily talk to my primary care doctor [about my OUD] because I don’t think it would be beneficial at all.”

–104, Female, 25 years

Provider training in treating substance use

“To get the license to prescribe [buprenorphine], apparently, it’s a very, very short course. There’s a lot to addiction. I mean, it’s a very complex thing. And it’s just not a one plus one is two… I don’t think they [general medical providers] have the amount of education for it.”

–112, Male, 34 years

Access to services

  

Counseling

“A [general medical provider] can probably do the medical part, but I still think a person still needs that treatment.”

-131, Female, 36 years

Peer support

“I’d rather do [integrated treatment]. If you’re an addict and you’re trying to stay clean, but you have to go somewhere every day where there’s a thousand other addicts there, that’s not good for people.”

–115, Female, 35 years

“I would probably go to a treatment program, and maybe if I had some other people to talk to and I could talk to people about what I’m going through, I wouldn’t feel as bad because I would hear their stories and stuff.”

–120, Female, 25 years

Structure and support

“The negative part about going to [a general medical provider] would be a lack of knowledge or tools to help me, and not having other people there who can support me. I would fully rely on him for treatment.”

–105, Female, 31 years

Patient-provider relationship

Pre-existing relationship

“When it comes to life or death, wouldn’t you want somebody, like your doctor, that you’ve met over and over again? That you felt a connection with?”

–119, Male, 42 years

“I went to [a general medical provider], and he was asking me some questions about do I use. And I really was like, ‘I don’t want to tell this man that!’ ‘Cause people look at you differently when they have to take care of you then. It seems like he did after I told him.”

–-131, Female, 36 years

Past experiences of disclosure

“He [general medical provider] knows all about my history, and that’s something that was really important to me in a doctor, to find somebody who I could be honest with, because you know, what good is it if you can’t be.”

–116, Female, 29 years

“She treated me differently once she found out I was an addict. I felt like everything shifted.”

–115, Female, 35 years

Trust

“They’re [general medical providers] trusted, and I already know who they are. It’s a good way, going with whatever the doctor that you have.”

–-132, Male, 28 years

“I don’t even trust [general medical providers] anymore. Like after everything I’ve been through, I don’t even trust doctors. I feel like it’s all a scam. I feel like they’re just out to make money… That’s it. They don’t really want to help you.”

-113, Female, 38 years

Comfort discussing substance use

“I feel comfortable talking with him [general medical provider] about everything. And the people at the clinic.”

-110, Female, 32 years

“If I was put in a situation where I would have to go talk to my doctor about my drug usage, I definitely would not feel comfortable with that.”

–127, Male, 33 years

Compassion

“They [general medical providers] just make you feel like you’re a person and not just like a frickin’ junk box.”

–110, Female, 32 years

“Most people in the medical field, a lot of them don’t show that caring… It’s just a cattle call.”

–102, Male, 57 years